| NPI | 1639420680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202011309) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 12767) |
| Enumeration Date | 2012-09-29 |
| Last Update Date | 2013-03-27 |